I understand that under the Health Insurance Portability & Accountability Act of 1996 (HIPAA), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to:
We would like to thank you for choosing Blue Mountain Psychiatry as your medical provider, as one of our patients we would like to keep you informed of our current office and financial policies. We require that you read and sign this document prior to any treatment, please keep this document for future reference.
Canceled Appointments: If you are unable to keep your scheduled appointment, please call our office within 24 Hours to reschedule. This will allow us to provide that time slot to another patient, otherwise you will be charging a $40.00 fee add to your account this will not be covered by insurance company.
No Insurance: Payment will be due at the time of service, if you are unable to pay your balance in full you will need to make prior arrangements with our customer service Representative or Financial Coordinator.
Insurance: please bring your insurance card with you at the time of your appointment, with insurance plans where we have agreed to participate in the network as a provider, your carrier requires that all Co-pays be paid prior to any services bring rendered
You are responsible for any Co-insurance, Deductibles or non-Covered services not paid by your insurance, you will receive a statement from our office indicating what your insurance has paid, any balance remaining is due upon receipt
Payment Refund: No return allowed on any service except the following cases